Suicide Risk Assessment & Management
Evidence-based framework for assessing and managing suicide risk, based on the work of M. David Rudd, Ph.D. and colleagues. Includes clinical decision tree, risk factors, warning signs, and intervention recommendations.
Fluid Vulnerability Theory (Rudd, 2006)
Fluid Vulnerability Theory is a diathesis-stress model that emphasizes the dynamic and shifting nature of suicide risk over time. It provides a framework for understanding, assessing, and intervening with individuals at risk for suicide.
The theory focuses on the risk assessment process rather than content, and addresses how cognitive, emotional, and behavioral factors interact to create varying levels of risk.
Baseline Risk
Enduring predispositions that confer suicide risk: age, gender, poor emotion regulation skills, negative core beliefs, poor problem-solving skills, substance use history, and trauma history.
Acute Risk
Time-limited elevations in risk triggered by life stressors that interact with baseline vulnerabilities. The “suicidal mode” becomes activated when stress exceeds coping capacity.
The Suicidal Mode (Rudd, 2000)
A cognitive-behavioral model conceptualizing suicidality as a “mode” that, once activated, involves simultaneous activation across multiple systems:
Cognitive
Hopelessness, perceived burdensomeness, cognitive rigidity
Affective
Intense psychological pain, desperation, emotional dysregulation
Behavioral
Impulsivity, agitation, preparatory behaviors
Physiological
Autonomic arousal, sleep disturbance, agitation
Rudd (2006) argues that certain individuals' suicidal mode is more easily triggered (e.g., those with multiple previous attempts) due to differences in these systems.
Brief Cognitive-Behavioral Therapy for Suicide Prevention (BCBT-SP)
Evidence Base: BCBT-SP reduced post-treatment suicide attempt rates by 60% compared to treatment as usual (Bryan & Rudd, 2015). Inpatient application (BCBT-I) reduced post-discharge suicide risk by 60%, ED visits by 75%, and hospital readmissions by 71%.
Phase 1: Safety
Risk assessment, crisis response planning, means restriction
Phase 2: Skills
Emotion regulation, distress tolerance, problem-solving
Phase 3: Relapse Prevention
Identify triggers, rehearse coping, maintain gains
Clinical Decision Tree
Step-by-step risk stratification with actionable interventions
Risk Factors & Warning Signs
Comprehensive list of acute and chronic risk factors
Emergency Detention Form
Fillable EOD form for involuntary psychiatric hold
Crisis Resources
988 Suicide & Crisis Lifeline: Call or text 988
Crisis Text Line: Text HOME to 741741
Veterans Crisis Line: 1-800-273-8255, Press 1
Trans Lifeline: 877-565-8860